Sunday, March 15, 2009

I Evidently Have The Ear Of President Obama, As I Should. We Will All Be Smarter As A Result.

I'll admit I've been a bit saddened that Barack hasn't called, or written, or even signed up to follow me on twitter since assuming the office of President of The United States. I mean, prostituting myself to those hicks in Iowa was no doubt instrumental in securing the good Karma that allowed him to capture the White House. Prostituting to hicks is always good for Karma, and I'm sure a vote or two. 

Don't get me wrong, it's not like I was expecting an ambassadorship or appointment as Secretary of Health and Human Services in return for my generous and unyielding support, although that would have been nice, and would have worked out better for the administration, considering I have always made it a point to keep my account with the IRS current. No my friends, all I really expected in return for getting behind my keyboard and making someone the most powerful person in the world was good government. And it looks like good government I am going to get. From the February 15th New York Times. 

Yes I said February 15th. I've only made claims that I am right about all things governmental, never that I am timely:

WASHINGTON — The $787 billion economic stimulus bill approved by Congress will, for the first time, provide substantial amounts of money for the federal government to compare the effectiveness of different treatments for the same illness.

Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and other ways of treating specific conditions.

I wrote about the problem about to be solved back in December. In a nutshell, companies are required only to prove a drug works better than a placebo to win FDA approval. Not that it works better than what is already on the market. So in most cases, there is zero scientific evidence that one med may work better or have a better cost/effectiveness ratio than another. Is Wellbutrin better than Prozac at treating your depression? Who the fuck knows? Might Buspar be a better alternative than benzodiapines for treating anxiety? Might as well have a chimp throw a dart against the wall to find out. The one time the government undertook a large scale head-to-head drug effectiveness study, focusing on hypertension meds, it found the cheap as dirt and rarely prescribed diuretic chlorthaladone to be the most effective med in preventing heart attacks, strokes, and heart failure combined.

Wow. we've only wasted a few katrillion dollars by not giving people the most effective hypertension treatment for the last few decades. Not to mention we all look really stupid. Well my friends, in case you haven't noticed, willful ignorance and stupidity no longer have an ally in the White House:

Dr. Elliott S. Fisher of Dartmouth Medical School said the federal effort would help researchers try to answer questions like these:

Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise and medications? What is the best combination of “talk therapy” and prescription drugs to treat mild depression?

How do drugs and “watchful waiting” compare with surgery as a treatment for leg pain that results from blockage of the arteries in the lower legs? Is it better to treat chronic heart failure by medications alone or by drugs and home monitoring of a patient’s blood pressure and weight?

Who would not want to know the answers to these types of questions? The stupid and willfully ignorant, that's who. Keeping that in mind, it'll be a big surprise whose name comes up in the next quote:

But critics say the legislation could put the government in the middle of the doctor-patient relationship.

Bureaucrats “will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost-effective,” Betsy McCaughey, a former lieutenant governor of New York, wrote on Rush Limbaugh broadcast the charges to millions who listen to his radio talk show.

Um......evidently you showed up to the train station a little late Betsy. Show me a doctor, any doctor, who isn't being monitored at this very moment by some suit to make sure they are practicing medicine in accordance with the suit's employer's interest. We've all heard of prior auths, yes? They've been happening for decades now. 

Well God fucking forbid that suit be representing the interests of the people of this country as opposed to a corporation mandated only to accumulate as many dollars as possible. God fucking forbid that suit be working for someone who can be held accountable for their actions. I distinctly remember having the chance to vote for Barack Obama. I clearly recall working on his behalf and against that of his opponent. I am also given my say every few years regarding other federal offices, such as Senator, or Congressperson. 

In contrast, I have yet to be offered a ballot in an Aetna election. Have you? No one at Aetna gives a fuck what I think, but I saw my Congressman at the gas station the other day, and chatted him up for a few minutes. No lie. My friggin' Congressman was pumping his own gas and getting told by one of his constituents he wants a single payer health care system. Try that with an executive from Aetna if you ever see them pumping their own gas. 

And while you're at it, imagine how far you'll get writing your Congressperson when Aetna gives you the shaft versus when a public system, overseen by Congress, gives you the shaft. 

Anyway, I'm getting ahead of myself. President Obama hasn't proposed a truly public health system yet, but he has taken a step towards things the Drugmonkey has been advocating, which makes him a pretty sweet-ass president so far. He also has yet to make up any bullshit reasons to start a war with a country that didn't attack us, which again, contrasts him favorably with his predecessor. 

Maybe we could get Rush on board by proposing a study of whether Oxycontin is more effective than Percocet at keeping the bugs off his skin. 

Fuck it. We don't need Rush on board. We are running the show now baby, and I don't need a study to tell me that's a vast improvement. 


Katie said...

Goddamn, you're awesome :)

arollerskatingjam said...

F*ck yeah. Amen to that!

Erik & Devan said...

Amen, Drug Monkey. Amen. Preach on brother!

Anonymous said...

Start Eating lots and lots of cheese. That should take care of your toilet paper problem and help the WI economy... It's a win win

Chip said...

Wowsers, you invented evidence-based medicine, too?

I see why you have such sycophants, now... lol

On a serious note, do you not think that insurance companies that require prior authorization are practicing evidence-based medicine? Do you not think that requiring higher copays on brand name meds is a subtle little hint to patients that maybe they should try something else that might work nearly as well but not be so expensive? You want to be the one explaining to patients that they can't even get a medication until they've tried 2-3 others that are cheaper first? Surely you don't think that there's no financial component to the 'evidence'? Surely you don't think that pharmaceutical companies won't lobby states/fed to accept 'bonuses' to get their meds paid for, despite the fact that they do it now?

Don't forget that drug companies are able to pay for antibiotic research because they make tons of money on Lipitor and Nexium and Viagra and the like. You want to suck away that revenue stream, stifling drug company innovation? For every Treximet, there's a drug that might save a life.

akfnp said...

Rock on DM!!!!!
what a potty mouth you have today..

DKLA said...

DM does make a point that doctors are monitored by insurances and that transitioning over to a government sponsored program will not have a significant difference.

Keep in mind that drug manufacturers are businesses and solely exist to make a profit. The only reason why they have a vested interest (ie R&D) in a new antibiotic is because they want to make money on it.

EBM is also heavily associated with the Cochrane Collaboration (which is a public domain in certain countries). The insurances can simply look up the information they need. The UK's NHS and the US's Agency for Healthcare Research Quality (a branch of HHS)are the ones that give out the gold standard in therapy (not any insurance PBM).

I support combo drugs in certain circumstances (ie compliance issues). Treximet (sumatriptan/naproxen) was merely pushed out since GSK lost the patent on Imitrex. A drug that costs $250+ can easily be replaced by a $70 generic with a bottle of $5 Aleve. That's not ingenuity that deserves praise, but a scam that should be scorned as professionals.

Beloved Parrot said...

The current president has also read and taught the Constitution; his predecessor couldn't read.

O Happy Day!

Chip said...

I'm not praising GSK for trying to foist Treximet on the market, don't get me wrong here. I can't say I blame them for trying to capitalize, because we all know idiots who will insist on it. I don't see how there are enough to make money on it, but they must know something or they wouldn't have done it (they are, after all, in it for the money).

On the other hand, I know for an absolute fact that drug companies fund research and outreach programs with the money they make from the profitable drug products. I know for a fact that they are searching for cures for diseases like malaria everyday.

And when, exactly, did profit become a bad thing? Anybody here single-handedly develop/isolate a drug, rigorously test that drug for effects (bad and good), effectively formulate that drug, then market it successfully? Until you do, reflect on that for a minute before you denigrate a drug company for doing it.

Utah Savage said...

Well, yes, you are awesome. I'm bipolar as you know, and I started taking Wellbutrin (prescribed by my Psychiatrist) as I was on my way to play a Judge in a movie. By the time I arrived on location I was psychotic, not just a smidge depressed. It did make for an interesting performance, but I wanted to kill everyone, not just throw them in jail.

Utah Savage said...

Even though I no longer can drink alcohol, Laphroaig was my scotch of choice.

DKLA said...

My rebuttal:

Abusive marketing for neurontin (gabapentin)

Basiorana said...

Well, with psychiatric meds, particularly antidepressants, so much is dependent on the individual that which one works better on average is irrelevant. Maybe it could give a starting point, but honestly, what psychiatric medicine needs is more FOCUSED trials. Finding out that Wellbutrin is better than Prozac for college-aged white people with depression doesn't actually tell us what works best for teenagers, middle-aged people, pregnant women, the elderly, people with other mental conditions like anxiety and OCD, etc. And finding out that overall, for a wide variety of patients, Prozac works best doesn't tell us if it works better for college-aged white people.

Definitely a step in the right direction, though. Maybe they can throw some strict anti-lobbying rules up, too, like "no drug company reps or drug company parephenalia within sight of the research building" and "any drug rep who approaches a researcher will immediately be arrested, and any drug company that sends them information will immediately be fined $100 million dollars."